Group Battlefield Acupuncture in Primary Care for Veterans with Pain

Objective: To obtain preliminary data on the short- and intermediate-term effects of battlefield acupuncture (BFA) on self-reported pain intensity in a relatively large cohort of veterans to assess whether a more comprehensive clinical trial evaluation is warranted. Methods: The treatment, in an outpatient group setting, consisted of up to five auricular semipermanent needles inserted into each ear at prespecified points. Efficacy of...

Mobile Health (mHealth) Use or Non-Use by Residents of West Virginia

Objective: To compare mobile health (mHealth) usage by residents of West Virginia with national estimates. Methods: Pew Research Center data from its Internet and American Life Project were accessed for secondary data analysis. These data, available to the public, are a probability sample of Internet use in the United States, differences in use based on selected variables (eg, education, household income), and how usage affects the lives of...

Risk, Outcomes, and Predictors of Clostridium difficile Infection in Lymphoma: A Nationwide Study

Objective: The risk of Clostridium difficile infection (CDI) has not been well studied in patients with lymphoma. We thus sought to determine the risk of CDI in hospitalizations with lymphoma along with its trend, outcomes, and predictors using a large database. Methods: Hospital discharge data from the Nationwide Inpatient Sample (NIS) from 2007 to 2011 were used for the study. Using the International Classification of Diseases, Ninth...

Uric Acid Control in Advanced Chronic Kidney Disease in a Southeastern US Urban Cohort

Objectives: Uric acid (UA) control may be insufficient in chronic kidney disease (CKD) patients in the current era. It is unclear, however, whether this is the result of environmental effects, patient anthropometrics or insufficient dosing of medical therapy (allopurinol). Methods: We have collected data on multiple clinical and laboratory parameters of 114 CKD clinic patients attending the nephrology clinic of the University of Mississippi...

OPEN ACCESS: Association Between System Factors and Acute Myocardial Infarction Mortality

Objectives: We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services’ 12-lead electrocardiogram capability, continuous percutaneous coronary intervention and cardiothoracic surgical...

Association Between the Frank Sign and Cardiovascular Events

Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was to summarize the clinical trials and observational studies that had examined the association between the Frank sign and cardiovascular diseases....

ICD Discussions: Closing the Gap between What We Say and What They Understand

More than 20 million adults worldwide have a diagnosis of heart failure (HF).1 The prevalence in the United States is expected to increase by 46% from 2012 to 2030, resulting in an increase from 5 million to 8 million Americans living with this condition.2 Approximately 50% of people diagnosed as having HF will die within 5 years.1 Implantable cardioverter-defibrillators (ICDs) are considered the standard of care to prevent sudden cardiac death...

OPEN: Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life

Objectives: Hypothyroidism results in decreased mood and neurocognition, weight gain, fatigue, and many other undesirable symptoms. The American Association of Clinical Endocrinologists, the American Thyroid Association (ATA), and The Endocrine Society recommend levothyroxine (LT4) monotherapy as the treatment for hypothyroidism; however, after years of monotherapy, some patients continue to experience impaired quality of life. Combination LT4...

Telerheumatology: The VA Experience

Objectives: We sought to characterize the correlation between diagnoses made during telerheumatology and face-to-face visits and to document patients’ satisfaction with telerheumatology visits. Methods: This quality assurance study of the use of telerheumatology evaluated new patients referred to a Veterans Affairs rheumatology clinic. Patients were seen at a community clinic by a nurse practitioner with a rheumatologist participating in...

Evaluation of Renal Function Estimation Formulas Specific to Dynamic Renal Function for Drug Dosing in Critically Ill Patients

Objectives: The study compared estimated creatinine clearance (eCrCl) between the Cockcroft-Gault (CG) equation and the Jelliffe, Chiou, and Brater equations designed for estimation in dynamic renal function and resulting antimicrobial dosing concordance of five antimicrobials (cefepime, meropenem, piperacillin/tazobactam, vancomycin, and fluconazole) commonly used in the intensive care unit (ICU). Methods: Electronic medical records were...

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Objectives: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is recognized increasingly as a distinct clinical entity and is associated with higher comorbidities compared with patients with asthma and COPD alone. Little is known about the leading causes of death related to ACO in the US general population, however. Our aim was to define the causes of mortality among patients with ACO compared with asthma and COPD in the US...

Minimal Use of Opioids for Pain Relief in an Internal Medicine Department

Objectives: The objective of the study was to determine if pain control was adequate despite our policy of limited opioid use. Methods: In this observational cohort study, we reviewed 300 consecutive patient charts from an internal medicine department. We extracted demographic data, as well as the patients’ primary diagnosis, pain on admission, daily pain evaluations (numerical rating score ), and treatment. Significant pain was defined as...

Clinical Context and Detection of the Murmur of Advanced Aortic Stenosis

Objectives: Auscultation is an important clue to the presence of aortic stenosis (AS). We sought to assess the effect of symptom status, prior knowledge of diagnosis, and other patient factors on murmur detection. Methods: Patients with moderate-to-severe AS by echocardiography at a single center between June 2015 and June 2016 were included. Five consecutive patient encounters (inpatient and outpatient) within 12 months before the...

Provider Variation in Antibiotic Prescribing and Outcomes of Respiratory Tract Infections

Objectives: Inappropriate antibiotic use for respiratory tract infection (RTI) is an ongoing problem linked to the emergence of drug resistance and other adverse effects. Less is known about the prescribing practices of individual physicians or the impact of physician prescribing habits on patient outcomes. We studied the prescribing practices of providers for acute RTIs in an integrated health system, identified patient factors associated with...

Single-Center Retrospective Study of Risk Factors and Predictive Value of Framingham Risk Score of Patients with ST Elevation Myocardial Infarction

Objectives: The objective of this study was to identify risk factors and clinical profile of the patients presenting with ST elevation myocardial infarction (STEMI). We further evaluated the utility of the Framingham Risk Score (FRS) in the accurate identification of these patients if used before their coronary event. Methods: We evaluated the demographic, clinical, and angiographic characteristics of patients admitted with STEMI. We also...

Diverticular Disease: The Old, the New, and the Ever-Changing View

Our understanding of diverticular disease has evolved significantly during the last 25 years, and as such, a reexamination is in order. We performed a literature search for the years 1960–2017 of PubMed, Medline, and Google Scholar for updates regarding the epidemiology, risk factors, and therapies for traditional diverticulitis as well as the recently described subtypes of diverticular disease, segmental colitis associated with...

Endobronchial Lesions in Patients Presenting with Hemoptysis

Objectives: The aim of this study was to determine the incidence of endobronchial lesions in patients presenting with hemoptysis. We also aimed to characterize features that would predict whether bronchoscopy would be useful. Methods: A retrospective chart review was conducted on 185 consecutive patients who presented with hemoptysis from January 1, 2006 to December 31, 2015 at Methodist Le Bonheur Healthcare–affiliated hospitals in...

Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents

Objectives: Hepatitis C virus (HCV) infection affects >3% of the US population, which over time can lead to cirrhosis and hepatocellular carcinoma. The lack of a reliable screening method for HCV before 1992 resulted in a higher prevalence of the virus in adults with congenital heart disease who underwent corrective surgery that required blood transfusions. Direct-acting antiviral agents such as sofosbuvir/ledipasvir have significantly...

Commentary on “Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents”

Advances in heart surgery in the past 50 years have provided a high level of survival in children born with congenital heart defects. The estimated number of adults living with repaired, unrepaired, or as-yet-unrecognized congenital heart defects exceeds 1.4...

Association of Anemia with Outcomes of Acute Heart Failure

Objectives: Anemia is common in patients presenting with acute congestive heart failure (CHF); when hemoglobin (HGB) declines to low levels, it can result in worse outcomes. The aim of this study was to determine a level of HGB on admission or discharge that affects outcomes in patients with CHF and then to evaluate the effect of the low HGB levels on these outcomes. Methods: We conducted a retrospective cohort study of 756 patients admitted...